LCIS newly D.C. -- Question about Hormone Receptor Status

Hi MelissaDallas. Thanks so muchfor your reply about not getting receptor status on your report from an NCI cancer center. Maybe I was wrong about this and this isn't just my hospital's policy? Maybe it is just assumed that LCIS is most likely ER+ so testing is not done and drug recommendations are made based on the high probability of ER+ status? I like your thinking about the weighing of quality of life issues. At my age, a possible stroke or broken hip seem worse than BC and make me understand why some choose PBMX to reduce their risk.

I'm still very new to this journey, so still trying to gather some facts to help me decide what to do.

Nicola Sue and Leaf: Thanks again for your replies. Leaf, that was a great link which I have bookmarked, thanks so much.

You both have me thinking about getting a second opinion on my pathology slides and maybe talking to an oncologist about the various drugs and their SEs. I was sort of surprised that my appointment was with the breast surgeon and not an oncologist. She basically handed me my path report and said see you in a year for a mammogram. Oh, and talk to you primary care dr. about taking exemestane for chemoprevention (after I said I was not a candidate for the SERMs because of clotting problems related to Lupus). Like I said before, I had to specifically ask about whether my hormone receptor status was tested, and she didn't know and had to look at the path report, then said I guess not -- it costs more to do that test and doesn't really change our treatment recommendations. I'm not convinced that she had read all the way to the end of the report where "pleomorphic" is mentioned briefly. (I hadn't seen that either because I was only just given the report.) I had read enough online to know that LCIS women are often seen more often, and may be referred for breast MRI's, so I asked about that. She said insurance will only pay for MRIs if your risk is above a certain level. It was only then that she said she guessed she could refer me to someone in the office who could run me through the risk calculator. When the nurse ran me through the risk calculator and my risk came up at 50% / 10 yrs. then finally the Dr. suggested that I should have a breast MRI in 6 mos. I know that I am a lot better off than many of her other patients, but I do have questions that I would like to have answered and want to be proactive about my care.

Late June: Mammogram w/BIRADS 4 suspicious microcalcifications; CNB dx ALH, with intraductal papilloma. Lumpectomy in late July, path report below

Diagnosis

Breast, right, wire localization lumpectomy

-- Lobular carcinoma in situ (see microscopic)

-- Atypical lobular hyperplasia

-- Intraductal papilloma, large/central type with duct ectasia

-- Radial scar and proliferative fibrocystic changes

-- Biopsy site changes

-- No evidence of invasive carcinoma.

Microscopic Description

Histologic section show multiple foci of atypical lobular hyperplasia surrounding the biopsy site cavity and the intraductal papilloma. Some of the foci show lobular expression and solid growth pattern, consistent with LCIS. LCIS are predominantly of low nuclear grade (classic type) with one focus showing an intermediate nuclear grade (pleomorphic type, slide A16). E-cadherin immunostains (x2) are negative within the in situ component, confirming the lobular nature. There is one area of adenosis that exhibits involvement by LCIS (slide A13). P63 immunostain demonstrates the presence of myoepithelial cells within this area and shows no evidence of invasive carcinoma. The other proliferative fibrocystic changes include usual ductal hyperplasia, adenosis, columnar cell changes and microcysts. Microcalcifications associated with LCIS and benign breast tissue are identified.